Patchy or splotchy brown and white markings on teeth can look alarming, but it’s a fairly common occurrence in young children. Typically these cases are often a condition called dental fluorosis, which is caused by overexposure to fluoride early in development. Some adults may go through life unaware that these “stains” are not caused by food, drink, or smoking; they are, from their early childhood. Fixing fluorosis is not always easy, but it can be done to improve the whiteness of teeth in adults and children.
What is Fluoride?
Fluoride is a mineral that is found within the earth’s crust and nature. Some natural food and water sources on the planet contain it organically. It can be found in fresh and salt water, as well as in some vegetation. Tea leaves also contain fluoride, and mature tea leaves and sometimes have 10 to 20 times the amount of young leaves from the same plant. There is fluoride in human bones and teeth, as well! It is commonly used in dentistry to strengthen enamel, which is the outer layer of teeth.
What is Fluorosis?
Around the time when a child’s first permanent teeth are growing in, at about eight years of age, they may be affected by a cosmetic condition that causes patchy brown stains on their teeth. This discoloration is caused by heavy exposure to fluoride, causing teeth to become pitted, irregular and stained from yellow to dark brown. The noticeable signs of fluorosis vary depending on the severity of the case, ranging from mild to severe.
Fluorosis was first noticed early in the 20th century when researchers found that people in the Colorado Springs area had an unusually high prevalence of stained teeth. It was then coined “Colorado Brown Stain” before it was given a more official scientific name. The Colorado Springs area also happened to have very high levels of fluoride in their natural water supply, giving people with stained teeth an unusually high resistance to tooth decay and cavities. This is how the discovery and idea of putting fluoride in public drinking water first came to be. The fluoride levels used for public drinking water were reduced to prevent the prevalence of fluorosis, but the decay-fighting properties of fluoride would still have its benefits in fighting off cavities.
How Common is Fluorosis?
Fluorosis is not a disease, but it is a cosmetic condition that can cause people to be unhappy with their smiles. Fluorosis affects about one in four Americans between ages 6 to 49. The highest rate of fluorosis is noticed in children between ages 12 to 15, in particular. The majority of cases can be considered mild, with about 2% qualifying as moderate and only 1% of cases at a severe level. It has been shown that the prevalence of fluorosis has increased since the 1980s, potentially due to the increase of oral hygiene products like mouthwash and toothpaste containing extra fluoride.
What Causes Fluorosis?
Since this condition is caused by overexposure to fluoride, it most often occurs when a child is ingesting too much fluoride at a young age. Many dental products like toothpaste and mouthwash contain extra fluoride along with artificial sweetener which can tempt children to swallow instead of spitting and rinsing it out. If a child is prescribed fluoride supplements with a dosage that is too high, it can also cause fluorosis. With fluoride in public drinking water, in fortified children’s fruit juices, and oral hygiene products, the exposure to fluoride can be too extreme for some children. It’s important for parents to be aware of this risk of overexposure in order to prevent fluorosis. While fluoride is important for mental health, too much of a good thing can cause damage.
Depending on the severity of the case, symptoms of fluorosis can vary from barely visible to very noticeable. Some teeth will look like they have tiny white specks across them while others look like large white streaks. Some more severe cases will involve pitting, which is a cork-like texture across the enamel of the tooth. Normal teeth with no fluorosis effects should be smooth and milky white. The ranges of fluorosis severity currently fall on this scale:
- Questionable: The tooth enamel starts exhibiting small white flecks or spots that are negligible until seen from up-close. Usually, dentists will be aware of these early stages and notice them quickly.
- Very Mild: After there is no question some fluorosis is present, a very mild case will show less than 25% of a tooth’s enamel covered in specks that appear opaque.
- Mild: If about half of the tooth is covered in opaque white areas, including opaque white streaks along with flecks, it presents a mild
- Moderate: These cases are very noticeable and more than half of the tooth’s enamel is covered in flecks and streaks as well as slight pitting or indentations.
- Severe: Cases that are this extreme are rare but are very obvious, even to the untrained eye. The tooth’s enamel is pitted with dark discoloration that appears dark brown long with white streaks and flecks.
Fluorosis Prevention and Treatment
Parents should be extra vigilant about their child’s intake of fluoride in the first 8 to 10 years of their lives. It’s a good idea to test local public water sources for levels of fluoride to ensure they are at a normal level. If homes use well water or bottled sources, a public health official can be called for testing to ensure safe levels of fluoride. Taking note of how much fluoride a child is ingesting via water, juices, and oral hygiene products is essential as well.
Treatment for fluorosis will always depend on the severity of the case. While it’s not dangerous, the condition can be visually displeasing. If someone wishes to lessen the visibility of fluorosis they can consult with their dentist about trying different methods including bonding, crowns, veneers, and MI paste, which can minimize discoloration.
There are options to lessen the visibility of fluorosis depending on the strength of a child’s adult teeth. Adults with fluorosis are also eligible for treatments to fix staining and improve their smiles. If you have questions about your child’s fluoride intake or need resources for water testing in your area, consult with your dentist.